Healthcare Provider Details

I. General information

NPI: 1245753441
Provider Name (Legal Business Name): JOHN ANDREAS DAHLE ACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MILL ST
HOULTON ME
04730-1877
US

IV. Provider business mailing address

PO BOX 867
PRICE UT
84501-0867
US

V. Phone/Fax

Practice location:
  • Phone: 207-532-6523
  • Fax: 207-532-3873
Mailing address:
  • Phone: 435-637-7200
  • Fax: 435-637-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10404540-6009
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: